My new client, Ms. J., has been struggling with hip pain for several months. Observing her gait, I realized her stride length was restricted, leading me to wonder about arthritic changes in the joint. Those fears were answered when the radiology report showed loss of space, but minimal joint degeneration.
“My doctor isn’t sure what to do, as the joint looks better than my pain level reflects,” Ms. J. said. “The pain is really affecting my lifestyle, and I just don’t know what to do anymore. My doctor thought coming to see you might be helpful. I know the flexibility isn’t good, but the hip is weak as well.”
“Show me how you know that,” I replied.
From a seated position, with her legs off the table, Ms. J. tried to hip-flex her right leg. It was clearly difficult, remarkably so compared to the left.
“Let me try something,” I said, while moving to the other side of the table. Placing my hands on her back, I slowly began to explore the multifidi and quadratus lumborum muscles. I examined them in minute detail, changing length tension relationships by altering flexion, extension, and lateral flexion movements of the lumbar spine. After releasing some exquisitely tender spots, I asked her to flex her hip again. She lifted her leg into much greater flexion and with far less effort.
“That’s crazy,” Ms. J. exclaimed. “That seems like a parlor trick or something.”
“No trick,” I replied. “Just systems theory applied to anatomy. Lifting your leg is like pulling a drawbridge closed. The leg is the bridge, and the chain is the muscle, but you need a wall to act as the anchor. That wall is your lumbar spine. Since your spine is moveable, the wall is made stable by the muscular contraction of your lower back muscles. If those muscles are compromised, the brain acts as a protective mechanism and shuts down the movement. I treat your back, the wall seems stable, and the brain allows you to lift the leg. Cool, huh?”
“Amazing,” she agreed. “So, this is a strength issue?”
“That’s just one piece of the puzzle, not the whole picture. Let’s explore more with you lying face down.”
With Ms. J. lying prone, I used the lower leg as a way to create internal and external femoral rotation. The smaller muscles around the trochanter seemed reticent to allow the movement to happen.
Picking up the skeletal model with trochanteric heads, I put it on the table next to her and demonstrated femoral internal and external rotation. She thoughtfully watched the movement, observing the rotation of the trochanter in the acetabulum.
“Now, let’s translate that into what you can feel,” I instructed. While I rotated her femur, I had Ms. J. put her hand over the joint to feel the motion.
“I can feel how there are some parts of the movement that are not smooth,” she said. “I can’t seem to let go of those areas. Why is that?”
“This seemingly simple motion is actually very complex. There are multiple muscles around the hip and, for the motion to occur, each must let go in a very precise order. Think of it like a symphony. Each instrument has an assigned role and must enter and exit at precise times. If the cello section won’t lessen its volume when the second violins take up the theme, the sound goes from sublime to chaotic.”
“Why do muscles do that?” Ms. J. asked. “What makes some muscles go rogue and why do they stay that way?”
“Great question; more research needs to be done to answer it. What I know is that my touch combined with your attention can help rewrite the software to push the muscular reset button.”
Resuming the movements, Ms. J. could feel her involuntary holding. “I want to let go, but how do I do that?” she implored.
“I don’t mean to be coy, but you will figure it out. I’ll keep doing the movement and you keep changing strategies until you discover how to let go.” She was not satisfied with my answer, which is understandable. It is, however, a really important point. Self-discovery is exactly that—self-directed learning.
Soon, the internal and external rotational movements became far easier. It was clear that something had changed.
“Somebody just figured this out,” I teased. “The orchestra is playing better.”
“Definitely,” Ms. J. said. “Do you know what the most amazing thing about this process is? I am feeling my own body, but at the same time I am witnessing it. I feel like I don’t have full control, but observing it changes it.”
“An amazing process,” I remarked.
Ms. J. agreed. “What is really amazing is that I feel like I am part of the audience and part of the orchestra at the same time!”

Douglas Nelson is the founder and principal instructor for Precision Neuromuscular Therapy Seminars, president of the 16-therapist clinic BodyWork Associates in Champaign, Illinois, and a trustee for the Massage Therapy Foundation. His clinic, seminars, and research endeavors explore the science behind this work. Visit www.nmtmidwest.com, or email him at doug@nmtmidwest.com.